Among young people living in shelters or on the streets, drug abuse is even more widespread than was thought - sometimes with tragic consequences.

In a study of 432 homeless youths in Los Angeles, 71 percent had an alcohol or drug abuse disorder or both at the time of the survey.

In a nationwide survey of 600 youths living on the streets, 50 percent of those who had tried to kill themselves said that using alcohol or drugs had led to their suicide attempt.

These are among the findings from three NIDA-funded studies that profile substance abuse among runaway and homeless youths and propose strategies for treating this hard-to-reach population.

In an analysis of three national surveys of substance use among youths ages 12 to 21 who had run away or been homeless at some point in their lives, Dr. Christopher Ringwalt, Jody Greene, and their colleagues at Research Triangle Institute in Research Triangle Park, North Carolina, found that:

For almost every drug surveyed, youths living on the streets had markedly higher rates of drug abuse than either youths in shelters or a comparison group of youths living at home. (For a sample of the study findings of drug use by street youths compared with drug use by youths living at home, see the chart below.)

Street youths were involved in more serious drug use than were youths living in shelters or at home. For instance, substantially more street youths than shelter youths used heroin and other injection drugs, methamphetamines, and crack cocaine.

For both street and shelter youths and for almost every drug surveyed, drug abuse rates were higher among older than younger youths, among males than females, and among Caucasians than African Americans.

At the time of the survey, some 75 percent of street youths were using marijuana; around one-third were using hallucinogens, stimulants, and analgesics; and 25 percent were using crack, other forms of cocaine, inhalants, and sedatives.

"These very high rates of drug abuse underscore the critical need for intervention and treatment services for runaway and homeless youths - a need that is not being adequately met," Dr. Ringwalt says. His work was supported by NIDA and the Administration on Children, Youth, and Families of the Department of Health and Human Services.

"But in planning interventions, we can't consider runaways and homeless kids as a single, homogeneous population," he points out. "As our data show, their rates of drug abuse vary widely depending on age, gender, ethnicity, and current living circumstances - street, shelter, or in a household on and off. Service providers need to take these differences into account when planning interventions."

"For example, to better reach street kids, service providers might increase the number and visibility of mobile vans and outreach staff and locate storefronts with street-wise staff in areas where youths congregate," Dr. Ringwalt says.

Dr. Michele Kipke and her colleagues at Childrens Hospital in Los Angeles found similar high rates of drug abuse in a survey of 432 homeless young people in Hollywood, California. The youths, aged 13 to 23, were recruited from clinics, shelters, and street hangouts. Among the major findings:

Age and gender were not significantly associated with substance abuse, but ethnicity was: as in Dr. Ringwalt's study, African-American youths were far less likely than were Caucasian youths to abuse alcohol or drugs.

The longer young people remained homeless, the more likely they were to have a substance abuse disorder.

"Our data show that abuse of alcohol and drugs is a pervasive and debilitating problem among street kids," Dr. Kipke says. "Special efforts are needed to hook up these kids with treatment services and other kinds of help such as life skills and job training. Some of them may need a pretreatment stage where their immediate crises are addressed through sheltering services and short-term detoxification."

Drug Use Among Street Youths Compared to Youths Living in Households

These contrasts in drug use among youths living on the streets compared
to those living in households were found when researchers at the Research Triangle Institute analyzed three nationwide surveys. The survey of
street youths asked about drug use from 30 days before the youths left home
until the day of the interview. The household youths were reporting any
use in their lifetimes. Thus, drug use for street youths may actually be
underestimated in the comparison.

"However, our study also suggests that those who need treatment the most may be the hardest to reach given their more chronic pattern of homelessness."

A particular risk for runaway and homeless youths who abuse drugs is suicide, according to another study by Dr. Ringwalt and his colleagues. In a nationwide, multicity survey of 640 youths in shelters and 600 living on the street, the researchers found that some 25 percent of the shelter youths and nearly one-third of the street youths had tried to kill themselves at least once in their lives. In both groups, those who had abused drugs - especially sedatives, hallucinogens, and inhalants - were far more likely than nonusers to have attempted suicide. For example, among street youths, 52.1 percent
of those who abused sedatives had attempted suicide, while 25.6 percent of those who did not abuse sedatives had tried to kill themselves.

An interesting finding was that runaways and homeless youths with substance-abusing family members were twice as likely as those without such family members to have tried suicide. This association remained significant even after taking into account the youths' own substance abuse.

"This finding adds to the scientific evidence that family substance abuse has a profound adverse effect on children," Dr. Ringwalt says. "It points to the need to focus suicide prevention efforts on runaway and homeless kids who use drugs and also have drug abuse in their families."

Both Dr. Ringwalt and Dr. Kipke say that their studies highlight the need for more aggressive outreach strategies to make comprehensive drug abuse treatment services more accessible to street youths. "Without substantial intervention, this most elusive population will remain at extreme risk for substance abuse and its adverse consequences," Dr. Ringwalt cautions.

Sources

Greene, J.M.; Ennett, S.T.; and Ringwalt, C.L. Substance use among runaway and homeless youth in three national samples. American Journal of Public Health 87(2):229-235, 1997.